Transcendent Health Clinic: RESEARCH CLINIC APPLICATION
SECTION I: APPLICANT INFORMATION
Full Name *
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Email *
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Date of Birth *
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Permanent Residential Address *
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Current Residential Address
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Country of Citizenship *
Your answer
SECTION II: RESEARCH CLINIC INFORMATION
Please select the condition that applies to what you are healing from: *
SECTION III: APPLICANTS DECLARATION & SIGNATURE
This research clinic provides holistic healing treatment at no cost in exchange for your written reflections on the process. I authorize Indigo International, acting on behalf of Transcendent Health Clinic to collect, use and disclose data and information I share about my healing. *
I understand that if I should be accepted into this research clinic, monthly holistic healing treatments are awarded as part of a grant from Indigo Education Foundation. The grants are provided for a period of 12 - 36 months. Therefore, upon acceptance into the research clinic I agree to commit myself to this healing process for at least 12 and up to 36 months. *
Applicant Signature *
Typing your name in the box below acts as your signature of this application.
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